TY - JOUR T1 - Emergency carotid artery stenting for progressive traumatic internal carotid artery occlusion JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000873 VL - 7 IS - 1 SP - e000873 AU - Yuta Oyama AU - Takeshi Uno AU - Masahiro Asami AU - Takahiro Onuki AU - Masahiro Shin Y1 - 2022/01/01 UR - http://tsaco.bmj.com/content/7/1/e000873.abstract N2 - A woman in her early 40s experienced an accidental fall down stairs requiring transfer to our hospital. When she arrived at our emergency department, her consciousness was clear, and assessment of vital signs revealed: heart rate, 62 beats/min; blood pressure, 174/119 mm Hg; respiration rate, 16 breaths/min; and saturation of percutaneous oxygen level, 100%. Neurological examination revealed motor paresis of the right upper and both lower limbs with sensory disturbances below the level of the 4th thoracic dermatome. Cervical CT showed dislocation between the 6th and 7th cervical vertebrae. Simultaneously, CT angiography showed stenosis of the right internal carotid artery (ICA), but cerebral blood flow remained normal (figure 1). The patient showed cervical cord injury classified as American Spinal Injury Association Impairment scale A and underwent emergency surgical vertebroplasty. However, postoperatively, she presented with mild paresis of the left upper limb. MRI of the head was performed on postoperative day (POD)1, disclosing cerebral ischemia of the right centrum semiovale and markedly reduced flow in the ipsilateral ICA. We started continuous administration of intravenous heparin, but left-sided hemiparesis remained unimproved. On POD2, second MRI disclosed further enlargement of the ischemic areas and defective flow signal in the right ICA (figure 2). This led us to perform cerebral angiography, showing near occlusion of the right ICA and no cross-flow from the left ICA. … ER -